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Development of Prostate Cancer Intramuscular Metastasis During 177 Lu-PSMA-617 Treatment
Victoria K Xie1, Amin H Jahromi
1Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO.
Clinical Nuclear Medicine
|April 8, 2026
Summary
Metastasis to muscle and subcutaneous tissue from prostate cancer is rare. This case highlights unusual soft tissue spread during 177Lu-PSMA-617 (Pluvicto) therapy, showing a mixed treatment response.
Area of Science:
- Oncology
- Radiopharmaceuticals
- Medical Imaging
Background:
- Prostate cancer metastasis to soft tissues like muscle and subcutaneous layers is uncommon and associated with poor prognosis.
- Metastatic castration-resistant prostate cancer (mCRPC) requires advanced therapeutic strategies.
- Lutetium-177 PSMA-targeted radionuclide therapy (177Lu-PSMA-617, Pluvicto) has shown efficacy in mCRPC.
Purpose of the Study:
- To report a rare case of intramuscular and subcutaneous soft tissue metastasis in prostate cancer.
- To illustrate a heterogeneous treatment response to 177Lu-PSMA-617 therapy.
- To discuss the implications of unusual metastatic patterns during advanced prostate cancer treatment.
Main Methods:
- Case report of a 61-year-old male patient with mCRPC.
- Clinical presentation of progressive gluteal/proximal thigh masses.
- Radiological assessment (imaging) during 177Lu-PSMA-617 treatment.
Main Results:
- The patient exhibited improved metastatic disease in lymph nodes and liver following Pluvicto treatment.
- Simultaneously, multifocal intramuscular and subcutaneous metastases developed in the left gluteal/proximal thigh region.
- This indicates a heterogeneous response to 177Lu-PSMA-617 therapy.
Conclusions:
- Intramuscular and subcutaneous soft tissue metastasis can occur in prostate cancer, even during effective systemic therapy.
- A heterogeneous treatment response, with improvement in some sites and progression in others, is possible with 177Lu-PSMA-617.
- This case underscores the importance of vigilant monitoring for rare metastatic patterns in mCRPC.
